How do we detect anxiety in teenagers?
The presentation of anxiety disorders in adolescence can vary from one teenager to another. Some of the symptoms that commonly appear are excessive fears and worries, restlessness and a tendency to be overly cautious, nervousness, and tension.
The defining characteristic of anxiety disorders is avoidance, at the behavioral level (actions), and intolerance of uncertainty, at the cognitive level (thoughts). Avoidance is sometimes very obvious, as when an adolescent with panic attacks and agoraphobia avoids going to public places for fear of experiencing anxiety symptoms, but other times it is more subtle, including, for example, excessive self-doubt, isolation, resistance, etc.
Furthermore, all anxiety disorders include in one way or another the anticipation of catastrophe or threat ("what if..."; "I will fail"; "they will laugh at me", etc.).
The basic differences between the different anxiety disorders will have to do with the content of these negative thoughts and the stimulus perceived as threatening.
| Disorder | Focus of fear |
|---|---|
| Separation anxiety disorder (SAD) | Fear of separation from attachment figures |
| Selective mutism (SM) | Fear of speaking in some situations (e.g., school), while speaking normally in others (e.g., at home). It typically begins in early childhood and usually resolves during childhood. |
| Specific phobia (SP) |
|
| Social anxiety disorder (Social phobia, FS) | Social situations in which the person may be exposed to examination by others. |
| Panic disorder (PD) | Panic attacks |
| Agoraphobia | Places from which escape may be difficult. |
| Generalized anxiety disorder (GAD) | Excessive worries (apprehensive anticipations) about everyday matters. |
| Obsessive-compulsive disorder (OCD) | Intrusive thoughts (obsessions) and compulsive behaviors. |
| Health anxiety | Fear of having an illness |
| Post-traumatic stress disorder (PTSD) | Traumatic experiences. |
In practice, these fears translate into avoidance and reassurance behaviors that allow one to have the feared stimulus "under control".
In the case of separation anxiety (more common in children than in adolescents), we find difficulties in separating from attachment figures. The child will avoid situations that require separation and will ask for help from their parents even in tasks that are not overly difficult and that they could handle alone.
In social anxiety disorder, we find shy adolescents who highly value the opinions of others, even more than their own. They often question their actions in social situations to the point of appearing inhibited or slow in their responses. Adolescents with social anxiety will avoid situations that require them to be exposed to the opinions of others. These can range from academic situations (oral presentations, asking questions in class, etc.) to social situations (eating or dancing in public, participating in group conversations with peers, etc.).
Anxiety in childhood and adolescence
Teenagers with generalized anxiety disorder (GAD ) may be preoccupied with everyday tasks like homework or exams. We might observe them excessively reviewing material, even after studying enough. They may also avoid listening to the news because of the distress it causes them or ask for advance notice of changes due to the difficulty they experience from a lack of control over their environment. In general, teenagers with GAD worry excessively about a wide range of everyday events, without focusing on any specific situation. They may worry excessively about catastrophes, their own health and/or that of their family, whether the start of classes is going well, or about something that happened a while ago—for example, a comment they made to a friend—and fear it will be misinterpreted, and so on.
In adolescents with panic disorder and/or health anxiety , we will notice that they are very attuned to bodily sensations and quickly detect even small changes, which they consult us about out of fear that these might represent a panic attack or a serious health problem. In the case of health anxiety, they may ask to be taken to the doctor, and in the case of panic disorder and/or agoraphobia, they may ask to go to a place where they feel safe (such as at home or a place from which it is easy to leave).
Differences between anxiety and fear
Post-traumatic stress disorder (PTSD) can manifest in various ways. A teenager might be hypervigilant, have difficulty sleeping and relaxing, and avoid talking about the traumatic event. Sometimes, they may resort to substance abuse to escape these traumatic thoughts and memories.
Finally, in obsessive-compulsive disorder , although it is often difficult to detect intrusive thoughts from the outside, we can observe compulsive behaviors, such as washing hands repeatedly, even when they are clean, etc.
This is an original article from the Escola de Salut de l'Hospital Sant Joan de Déu Barcelona , from the 12th FAROS Report "A look at the mental health of adolescents - Keys to understanding and supporting them".
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